Provider Demographics
NPI:1144541749
Name:MAHER, JEREMY MICHEAL (BA)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:MICHEAL
Last Name:MAHER
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7061 LARK RD N.W.
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:OH
Mailing Address - Zip Code:44644
Mailing Address - Country:US
Mailing Address - Phone:330-323-6864
Mailing Address - Fax:
Practice Address - Street 1:919 SECOND ST. N.E.
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704
Practice Address - Country:US
Practice Address - Phone:330-454-7917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator